Align, Convene, and Organize: Facilitating Behavior Change is the Key to Success in Accountable Care Organizations

The challenge of changing behavior in order to realize the ROI on IT systems is not unique to healthcare

Accountable Care Organizations (ACOs) are healthcare systems that the government incentivizes to improve the health outcomes and costs for treating Medicare patients. The approach is being widely adopted, and is being copied and adapted by private insurers, too. But moving the needle on system-wide cost and quality for a patient demographic is proving very difficult to do. In fact, 9 of the 32 earliest ACOs dropped out or downgraded their arrangement to a lower risk/lower reward contract. One of the most challenging difficulties is the fact that identifying and coordinating care for the sickest patients depends on IT capabilities that only the wealthiest and most mature systems have yet developed. And even though much of ACO consulting concerns the implementation of electronic health record systems, leaders of ACOs are also finding that it is a real challenge to convert patient data into consistent system-wide collaboration that improves cost and quality.

The challenge of changing behavior in order to realize the ROI on IT systems is not unique to healthcare. Many of our clients have invested in CRM, logistics, or dispatching systems, only to find that they need a significant program of initiatives to discover and implement the behavioral shifts that drive results. Sadly, it is a common mistake to invest in new IT capabilities, but overlook the hundreds of adjustments to individual and group behaviors that must be made in order to achieve consistent, measurable results. And many leaders don’t understand the important roles that they play in encouraging this kind of experimentation and behavioral change.

Leaders of Accountable Care Organizations (or any organization) who want to encourage these critical behavioral shifts can follow a different ACO acronym – in this case ACO stands for “Align, Convene, and Organize.”

Align means making sure everyone is pointing in the same direction. Leaders align their organizations when they make tough calls about which metrics matter – and when they set a very specific, tightly scoped stretch goal for the system to hit. One of the challenges for health care systems is that there are too many metrics, and that many of them conflict with one another. A hospital CEO’s dilemma of how to trade off the control of system costs while maximizing hospital admissions and utilization is a classic example. And physicians often juggle their individual performance against what’s best for patient experience, their colleagues, and the overall system. Without a clear focus on a well-defined metric like “Reduced admissions and length of stay for male Type 2 diabetics age 45-50,” there is simply too much room for variance, and individual efforts to do the right thing will not scale up for system-wide impact.

Convene means bring people together. One of the most powerful – yet underutilized – things that leaders can do is to bring together people from different departments, practices, and organizations, to develop a shared understanding of the issues and opportunities that surround the system’s most important goals. Our own research on innovation in organizations shows that successful innovation happens when people have temporary structures for working together, when they can frequently and easily exchange information, and when they have a well-defined stretch goal to pursue. Improving health outcomes for a system’s sickest patients requires engagement of many different stakeholders. A process like GE’s WorkOut or Kaizen can be useful – if the challenge is well defined and it leads to disciplined implementation.

Organize refers to the basic blocking and tackling of execution – with a special emphasis on learning and adaptation. Set clear goals for implementing new ideas and moving the needle on outcomes. Leaders can demand concrete plans – but ask for regular updates not just on these activities, but on the metric that matters, so people understand that the result is more important than completing a to do list. Status review sessions need to focus on learning about what’s working, encouraging adaptation, and planning about how to encourage others to adopt the new behaviors; they need to be much more than sterile project reviews and presentations.

As the health care environment changes and health systems adapt, changes must reverberate through organizations, work groups, and individuals before we will start to see consistent improvement. By following the ACO principles of Align, Convene, and Organize, leaders of health care systems can focus people on what matters most – and create the accountability that’s needed to attain it.